【作者】 王垚；

【导师】 尹爱田；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 改革开放以来，随着我国经济的快速发展，人民的生活水平显著提高。但是，在经济增长的同时，我国的医药费用也出现了快速上升的现象。特别是自上世纪90年代以来，医药费用的增长速度明显快于GDP的增长速度。医药费用的过快增长，加重了人民的经济负担，导致了“看病贵”、“因病致贫、因病返贫”的现象，不利于“人人享有卫生保健”的目标的实现，不利于和谐社会的建设。因此控制医药费用的过快增长势在必行。近年来，国内外已经对医药费用增长因素和控制措施展开了大量的研究，但是这些研究大部分只针对某一项政策措施进行研究，缺少对医药费用控制政策的系统研究，尤其是国内还缺少对医药费用影响因素的量化研究。这些研究对于我国进一步了解医药费用增长的影响因素，并进而控制医药费用，具有十分重要的意义。本研究的主要目的是针对医药费用过快增长现象，探讨社会经济大背景条件下的控制医药费用过快增长政策的关键技术。根据研究的目的，本研究的主要内容为：1)摸清医药费用增长现状及成因，明确需要解决的关键问题。2)分析现有政策效果，明确现有政策的障碍。3)提供解决政策问题的关键技术，为控制医药费用政策的制定和落实提供思路。本研究以山东省为样本，通过山东省1987年到2005年的医药费用数据，对医药总费用及其影响因素进行多因素分析，构建医药总费用的方程，并对近年来国家出台的控制医药费用过快增长的主要政策进行定性分析，从GDP增长前提下卫生宏观政策的关键技术和医疗卫生人力控制微观政策的关键技术两个方面，提出控制医药费用过快增长政策的关键技术。本研究的资料主要来源于中国统计年鉴，山东省卫生统计年鉴，国家统计局网站，山东统计信息网，以及现有的国内外文献资料。本研究的主要结果：1)在医药费用增长的构成上，药费与检查治疗费是增长的主要方面，其中，在住院服务上增长得更快。2)在不同经济水平发展地区之间，门诊服务费用水平没有显著差别；住院服务费用水平在经济发达地区和经济欠发达地区、经济发达地区和经济较发达地区之间有显著差别，经济较发达和经济欠发达地区之间没有显著差别。3)在门诊服务和住院服务的利用上，居民主要选择县及县以上医院就诊。4)在医药费用增长的影响因素上，GDP和卫生技术人员数是主要因素。这说明，医药费用的增长，有较大部分源于经济的增长，由于人民生活水平的提高，医疗需求增加，从而导致医药费用增长；同时，卫生技术人员数也是导致医药费用增长的关键因素，这说明医疗机构人力成本的增加和诱导需求的存在导致了医药费用的增长。5)我国现行的药品价格管理、医疗服务价格管理、药品收支两条线、医疗保险等政策在控制医药费用增长方面效力仍显不足。本研究通过医药总费用方程，结合现有政策的分析，提出两大方面控制医药费用增长政策的关键技术。1．GDP增长前提下卫生宏观政策的关键技术：1)卫生服务体制改革：建立公共服务型政府；提供基本医疗，引入市场竞争机制；筹资和分配政策向公共卫生机构和基层医疗机构倾斜；2)药品政策的关键技术：药品产业控制，新药审批，流通模式改革，集中招标采购，医药分业；3)价格管理政策的关键技术：药品定价原则，扩大药品定价范围，医疗服务价格定价原则；4)医疗保险政策的关键技术：全民覆盖，基本医疗统筹，区域统筹，商业保险，支付方式改革。2．医疗卫生人力控制微观政策的关键技术：1)合理设置机构和岗位，明确机构和岗位职责；2)优化医院内部管理运作流程；3)建立科学的绩效评价体系。更多还原

【Abstract】 From reforming and opening, the medical expenditure has been increasing for a few years while the economy is developing in China. The high medical expenditure decreases the welfare of people. So it is imperative to control the medical expenditure growth under this situation.International and domestic scholars have made a lot of studies on the medical expenditure control. But most of them focus on one policy not systematic and integrated policies. Especially there are short of studies on statistic analysis of factors which affect the increasing of medical expenditure. So this study is based on above research background.The main research contents of this study are: 1) Getting known the situation of medical expenditure growth. 2) Analyzing the effects of existing policies. 3) Providing the key technologies of medical expenditure growth control.Data of Shandong Province from 1987 to 2005 are used in this study. The results of Multi-factors analysis show that 1) medicine and examining expenditure are the most primary constitutions of medical expenditure, especially in in-hospital services; 2) the out-hospital expenditure is not significant between developing, pre-developed and developed areas, and the in-hospital expenditure is significant between developing and developed, pre-developed and developed areas, but not significant in developing and pre-developed areas. 3) Residents always utilize in-hospital and out-hospital services in county or upwards hospitals. 4) GDP and health technology population are the key factors which lead to medical expenditure growth. These mean that the economy development, hospital human resource cost and induced demand deeds are the reasons that the medical expenditure increases. 5) There are many bugs in medical expenditure control policies in China.Combining with the multi-factors analysis and the existing policies analysis, this study provides two key technologies on medical expenditure growth control, including 1. Macro health policies key technologies with the GDP growth. 1) Health service system innovation: public servicing government which is dominant in health care, providing basic healthcare, introducing market competition; financing and funds distribution to public health institutions and basic health institutions. 2) medicine policy key technologies: medicine industry control, new medicine examining and approving, circulating style innovation, centralizing inviting public bidding purchasing, separating of hospital and medicine; 3) price management policy key technologies: regulating medicine prices, extending the scale of medicine which is regulated price, regulating health service prices; 4) health insurance policy key technologies: covering all people, planning as a whole in basic healthcare and chronic diseases, regional planning as a whole, commercial insurance, payment innovation. 2. Health human cost control micro policies key technologies. 1) Setting the institutions and posts in hospital rationally, specify the responsibility of the institutions and posts; 2) Optimizing the process of management and service in hospital; 3) Establishing the scientific performance estimation system.更多还原